Public health agencies adapt COVID lessons to curb overdoses, gun violence

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KHN (Kaiser Health News) is a national newsroom that produces detailed journalism on health issues. KHN, along with Policy Analysis and Polling are the three main operating programs of KFF. KFF is an endowed non-profit organization that provides information to the nation on health issues.

LIVINGSTON (Montana) — Shannan Piccolo entered a hotel carrying a bag filled with Narcan and a speech about the ease of using the medication that can reverse opioid overdoses.

Piccolo, director, Park City County Health Department told the hotel manager, “Hopefully your business wouldn’t have to respond to an accidental overdose.”

Piccolo’s instructions regarding Narcan, which is the brand name for the drug naloxone was listened to by the manager who added four nasal sprays to the first-aid kit of the hotel.

The transaction took less that 10 minutes. Piccolo was visiting the third hotel in Livingston on a hot July day. Livingston is a mountain community of approximately 8,000 people. Health officials in Livingston are concerned about the recent increase in use of synthetic opioid fentanyl.

This was the first time that a local health department provided door-to-door supplies and training to help prevent overdose deaths. The pandemic was the time when local health officials distributed vaccines and rapid tests in high-risk areas.

“We learned it from COVID,” Dr. Laurel Desnick said, the county’s public-health officer. “We reach out to those who might not be able to come to us,” Desnick said.

The U.S. pandemic exposed the inequalities and gaps in its public health system. This often led to backlash against officials who tried to stop the spread of the coronavirus. One positive outcome is that health workers are now applying the lessons learned from COVID-19 to other aspects of their work, partly because of the federal funding.

In Atlanta, county health department plans to mail at-home kits for testing for diseases to people. This program is based on the distribution COVID rapid tests. Houston health officials announced that they will begin monitoring the city’s wastewater for monkeypox. This tactic is widely used to determine how quickly COVID spreads. Chicago government agencies have modified COVID collaborations in order to tag-team an increase in gun violence.

These adaptations are relatively inexpensive and easy to include in departments’ post-pandemic efforts, such as the use of vans purchased with COVID relief money to deliver vaccines and test for disease. Other tools are more expensive and take longer to implement, such as updating COVID-borne surveillance systems and data.

Some public health workers fear that the lessons learned from their work will be lost once the pandemic is over.

Adriane Casalotti, National Association of County and City Health Officials, stated that funding cycles tend to be boom-and-bust when there are public health crises.

While some federal pandemic relief funds are expected to last for many years, other allocations have already run out. Local health workers will have to decide what to fund with the remaining funds.

Despite being historically underfunded and short-staffed, health services are still responding to the challenges that were intensified by the pandemic.

Casalotti stated that you don’t have to start from the same place as 2 1/2 years ago. There’s a higher mountain to climb. “But, places that have been able to build some of their systems can adapt these to allow for greater real-time understanding and response to public health problems.”

Fulton County Board of Health in Atlanta has offered free at-home testing for sexually transmitted disease to residents. The state had historically the highest rates of STDs reported in the country.

Joshua O’Neal (the county’s director for the sexual health programs), stated that the program “has the power to demonstrate scalable effects of equitable accessibility to historically underserved community,” in a press release.

These changes transcend government. Researchers at the University of Texas are creating a state-wide program to collect data about fatal and non-fatal opioid overdoses. The project’s participants are disappointed that the national effort to monitor COVID epidemics hasn’t been extended to the overdose epidemic.

Commissioner of the Chicago Department of Public Health Dr. Allison Arwady said that her team is expanding COVID data-driven approaches to track and report on neighborhood-level opioid drug overdoses. The pandemic has brought together city agencies and non-profits who have been working together to examine the data to help shape their response.

Arwady stated that the city will use the pandemic-driven increase in money and attention to fund programs that can endure beyond the COVID emergency.

“Everyday, we have these discussions about, How big do we go?'” Arwady asked, “How far can we go?” It’s a great moment. We have shown what COVID can do, and we have shown what we could do with additional funding.

To counter gun violence, the city also opened a new safety centre. It was modeled after its COVID response base. For the first time, employees from all departments of the city are working together to address safety concerns. They track data and connect people in high-risk areas with services.

Separately, the neighborhood-based organizations that were originally created to manage COVID contact trace and education are now shifting their focus to food security, violence prevention and diabetes education. Arwady stated that she plans to continue grassroots public-health efforts in areas where there are long-standing health disparities using a mix of grants to retain 150 people originally hired by pandemic relief dollars.

Arwady stated, “The message that I have been really telling my team was, ‘This our chance to do things we have long desired to do.'” “We made some of it up, and I just, oh my god, am gonna kick and scream until that all gets dismantled.”

Desnick, back in Montana, stated that not all change is dependent on funding.

The Park County health department used a database of contacts it had compiled during the pandemic in June to update schools, churches and businesses about the damage caused by flooding in Yellowstone National Park.

Desnick regularly posts public health video updates. He started with COVID case count and expanded to include flood levels and federal cleanup assistance.

Piccolo, the county’s chief health officer, spent approximately an hour visiting Livingston’s core hotels to provide opioid overdose response training. Three hotel managers accepted the offer. Two asked Piccolo to return later. One scheduled an all-staff training later in that week. Piccolo plans on expanding the program to music venues and restaurants.

This adaptation is not dependent on the continual flow of COVID assistance. The Narcan boxes were provided by the state. She said that it was not about the time taken to do this.

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